158 - Predictive Risk Factors and Outcomes of Platelet Transfusions in Very Low Birth Weight Infants in the Neonatal Intensive Care Unit

Publication Number: 2152.158

Surya Manickam, Los Angeles General Medical Center / Children's Hospital Los Angeles, Los Angeles, CA, United States; Hemananda Muniraman, Los Angeles General Medical Center, Los Angeles, CA, United States; Amy Yeh, USC/Los Angeles General Medical Center, Los Angeles, CA, United States; Smeeta Sardesai, University of Southern California, Los Angeles, CA, United States; Rowena Cayabyab, Los Angeles General Medical Center, Los Angeles, CA, United States

Background: The practice of platelet transfusions in neonatal units varies between institutions. Recent data suggests that platelet transfusion is associated with a higher incidence of death, bleeding, bronchopulmonary dysplasia (BPD), or severe neurodevelopmental impairment in preterm infants, regardless of the indication for transfusion.

Objective: Our objective was to evaluate the risk factors and outcomes associated with platelet transfusion in very low birth weight (VLBW) infants where a platelet transfusion threshold of 70,000 per microliter and/or acute bleeding was used.

Design/Methods: Retrospective cohort study of all VLBW infants admitted to a Level III NICU at Los Angeles General Medical Center from 2009 to 2024. Maternal and neonatal demographics and short-term outcomes were collected from the electronic NICU database and electronic medical records. Infants were grouped into those who received platelet transfusions and those who did not. Chi-squared, t-test, Wilcoxon rank sum, and multivariate logistic regression were used to determine associations between variables and platelet transfusion.

Results: Data from 955 VLBW infants were included in the study. 204 infants (21%) received platelet transfusions, with a median of 2 transfusions (IQR 1-4). There was no difference in birth weight or gestational age between the VLBW infants with or without platelet transfusion. However, significant risk factors associated with platelet transfusion included maternal pre-eclampsia with severe features, chronic hypertension, antenatal steroids, and small for gestational age (SGA). (Table 1) Maternal pre-eclampsia with severe features, SGA and maternal diabetes remained significant, after adjusting for other variables. (Table 2) Infants with platelet transfusion had a prolonged length of stay and a higher rate of chronic lung disease (CLD) (OR 1.16 {95% CI 1.07, 1.24}; p value < 0.01), after adjusting for gestational age and antenatal steroids.

Conclusion(s): Our study indicates that VLBW SGA infants exposed to maternal pre-eclampsia with severe features is a significant risk factor for platelet transfusion while maternal diabetes appears to be protective against platelet transfusion. There is a 2 fold increased risk to develop CLD in these infants and it increases by 16% for every platelet transfusion. These findings, in addition to the current evidence, prompted us to change our platelet transfusion guideline. Further research is needed to determine whether a decreased platelet transfusion threshold for asymptomatic infants would yield a similar conclusion.

Table 1: Predictive Risk Factors and Outcomes of Platelet Transfusions in Very Low Birth Weight Infants


Table 2: Multivariate Logistic Regression of the Predictive Risk Factors of Platelet Transfusions in Very Low Birth Weight Infants